Blue-light imaging compared with high-definition white light for real-time histology prediction of colorectal polyps less than 1 centimeter: a prospective randomized study.

Abstract

BACKGROUND AND AIMS\nBlue-light imaging (BLI) is a new chromoendoscopy technique, potentially useful for differentiating neoplastic from nonneoplastic lesions. The present study was aimed at comparing BLI with high-definition white light (HDWL) in the real-time histology prediction of colon polyps\xa0<10\xa0mm.\n\n\nMETHODS\nConsecutive outpatients undergoing colonoscopy with the ELUXEO 7000 endoscopy platform and 760 series video colonoscopes (Fujifilm Co, Tokyo, Japan) who had at least 1 polyp\xa0<10\xa0mm were randomized to BLI or HDWL for polyp characterization. The accuracy of high-confidence real-time histology prediction (adenoma vs not adenoma) by either BLI or HDWL for polyps\xa0<10\xa0mm (primary end-point) and diminutive (≤5\xa0mm) polyps was calculated, along with sensitivity, specificity, and positive and negative predictive values, with histopathology as the reference standard.\n\n\nRESULTS\nA total of 483 polyps were detected in 245 randomized patients (125 and 120 in the BLI and HDWL arms, respectively). A total of 358 were diminutive, and 283 were adenomas. Overall, 222 (85.7%) and 193 (86.1%) polyps were characterized with high confidence by BLI and HDWL, respectively (P\xa0= .887), with an overall accuracy of 92% and 84%, respectively (P\xa0= .011). The accuracy was significantly higher by BLI\xa0than HDWL, also for diminutive polyps (92% vs 83%; P\xa0= .008). When BLI was used, the negative predictive value for diminutive rectosigmoid polyps was 88%, and the post-polypectomy surveillance interval was\xa0correctly attributed in 85.7% and 93.7% of patients, respectively, according to U.S. and European guidelines.\n\n\nCONCLUSION\nBLI was superior to HDWL for the real-time prediction of histology in polyps\xa0<10\xa0mm. A BLI-dedicated classification might further improve the endoscopist performance. (Clinical trial registration number: NCT03274115.).